Guggenberger Konstanze V, Riedling Lukas, Kern Daria, Werner Rudolf A, Vogt Marius L, Fröhlich Matthias, Schmalzing Marc, Pham Mirko, Bley Thorsten A
Department of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
Rheumatol Int. 2025 Jan 13;45(1):27. doi: 10.1007/s00296-024-05765-4.
Diagnosis of Giant Cell Arteritis (GCA) and Polymyalgia rheumatica (PMR) may be challenging as many patients present with non-specific symptoms. Superficial cranial arteries are predilection sites of inflammatory affection. Ultrasound is typically the diagnostic tool of first choice supplementary to clinical and laboratory examination. Inflammation of temporal arteries can be detected sonographically with high reliability. However, due to the vessel's course and location, occipital arteries evade sonographic detectability.
The aim of our study was to evaluate the infestation pattern of superficial cranial arteries in GCA and PMR patients with special focus on the occipital arteries.
90 treatment-naïve patients with clinically and/or histologically proven GCA and/or PMR (51 GCA, 20 PMR, 10 GCA-PMR) were included in the study. All patients underwent contrast-enhanced, fat-suppressed, high-resolution black blood 2D T1-weighted spin echo imaging at 3T MRI. Images were read by three different readers independently. Temporal and occipital arteries were assessed regarding vasculitic affection. Circumferential mural hyperenhancement and thickening of the vessel wall ≥ 600 μm was considered positive for vasculitis.
9/90 (10%) of all patients revealed inflammatory changes of the occipital artery only. Prevalence of isolated inflammatory affection of occipital artery was even higher in the GCA subgroup with 7/51 (14%) patients.
14% of GCA patients and 10% of GCA-PMR patients present with signs of inflammation of the occipital artery only. Since the occipital artery is not accessible to routine ultrasound examination, MRI renders incremental value in the diagnosis of GCA and PMR patients.
巨细胞动脉炎（GCA）和风湿性多肌痛（PMR）的诊断可能具有挑战性，因为许多患者表现出非特异性症状。颅外浅表动脉是炎症易累及的部位。超声通常是临床和实验室检查之外的首选诊断工具。颞动脉的炎症可以通过超声可靠地检测到。然而，由于血管的走行和位置，枕动脉难以通过超声检测到。
我们研究的目的是评估GCA和PMR患者颅外浅表动脉的受累模式，特别关注枕动脉。
90例未经治疗的临床和/或组织学证实为GCA和/或PMR的患者（51例GCA，20例PMR，10例GCA-PMR）纳入研究。所有患者均在3T MRI上接受了对比增强、脂肪抑制、高分辨率黑血二维T1加权自旋回波成像。图像由三位不同的阅片者独立阅片。评估颞动脉和枕动脉的血管炎受累情况。血管壁周向强化和增厚≥600μm被认为血管炎阳性。
所有患者中有9/90（10%）仅表现为枕动脉的炎症改变。在GCA亚组中，枕动脉孤立性炎症受累的患病率更高，有7/51（14%）的患者。
14%的GCA患者和10%的GCA-PMR患者仅表现出枕动脉炎症的迹象。由于枕动脉无法通过常规超声检查，MRI在GCA和PMR患者的诊断中具有额外价值。
